Computerized physician order entry systems and medication errors.
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Clinical Pharmacy Information Systems↗
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Computerized physician order entry systems and medication errors.
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Clinical Pharmacy Information Systems↗
Prehospital resuscitation in Helsinki, Finland.
Helsinki, a city of 500,000 inhabitants, is served by a two-tiered emergency medical system with basic emergency medical technicians in ordinary ambulances and one physician-staffed prehospital emergency care unit. All 266 patients with prehospital cardiopulmonary resuscitation during 1987 were studied. Two hundred twelve patients with presumed heart disease and a witnessed arrest were analyzed further. Their response times for basic life support and advanced life support were 5.5 and 10.7 minutes, respectively. The initial cardiac rhythm in 144 patients (68%) was ventricular fibrillation. In 79 of these patients, cardiopulmonary resuscitation was successful, and 39 patients (27%) were discharged from hospital. The patients who survived had shorter response times for basic life support and their arrest locations was more often outside home, compared with the nonsurvivors. The results seem comparable with emergency medical systems in the United States, but a need to reduce response times is identified.
Aged↗
Exploring the functions of World Wide Web-based electronic medical record systems.
The recent increase in publications regarding implementations of World Wide Web-based electronic medical record systems makes it necessary to compare different systems and to understand how they support particular needs. This paper develops a framework and a coarse metric by which these Web-based systems can be classified and eventually compared.
Computer Communication Networks↗
Implementation of an electronic medical record system in a pediatric psychopharmacology program.
The design, implementation, and utilization of an electronic medical record system (EMRS) in a pediatric psychopharmacology clinic is described. The EMRS is a relational database with information entered directly by the clinician during a patient visit. It has been used during more than 2590 patient visits with 805 patients. Complete clinical documentation and simultaneous data entry as well as computer generated prescriptions for the patient were accomplished 75% of the time within a 20-min medication management session. One hundred consecutive parents of patients were asked to fill out a five-question survey to begin to assess the impact of the application. Of the 87 parents who responded, all (100%) noted that the doctor paid attention to their concerns. Between 88 and 90% of the parents reported that the use of the computer is a 'good' thing, made it easier to work with the doctor, and that they understood why the computer was being used. The findings support that the development and implementation of an EMRS with direct clinician information entry within pediatric psychopharmacology clinic, is feasible.
Attitude to Computers↗
Acceptability of Unified Medical Language System terms as substitute for natural language general medicine clinic diagnoses.
The acceptability of using the Unified Medical Language System (UMLS) concept phrases to substitute for physicians' diagnosis statements was investigated. Physician diagnosis statements recorded in the University of New Mexico's General Medicine Clinic were input into a computer program that automatically finds the best matching UMLS concept phrases. The computer program written in C++ integrates UMLS searching and browsing with a graphical user interface. Five attending physicians in the Department of Internal Medicine rated the acceptability of the UMLS concept phrase as a substitute for the original physician statement. One hundred and ninety-five patients' notes were examined with 447 diagnosis statements recorded of which 271 statements were unique. Attending physicians rated their satisfaction with the automated UMLS substitutes on a scale of 1 (extremely dissatisfied) to 5 (extremely satisfied). Intrarater (mean 0.94) and interrater correlations (mean 0.75) were high. The mean rating was 4.0 (quite satisfied). Most (73%) of the substitution were satisfactory (rating of 4 or 5), 16% were neutral (rating of 3), and 21% were unsatisfactory (rating of 1 or 2). A review of the substitutions showed a frequent lack of clinical modifier terms in UMLS as has been previously described. Comparison to a previous study shows the broader term coverage of UMLS to be a more acceptable source of diagnosis codes than using International Classification of Diseases revision 9 alone. These results suggest that UMLS can be an effective tool for coding unconstrained physician diagnoses.
Consumer Behavior↗
Special report on health care delivery systems and medical staff relationships. Peer review in the era of integrated delivery systems: it's time for some massive paradigm shifts.
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Antitrust Laws↗
Prevalidation of computer systems regulating medical device manufacturing processes.
When developing a computer system for regulating a medical device manufacturing process, it is advisable to incorporate validation criteria in the design and development of the system from the very beginning. Quality begins at the design stage and cannot be added at a later stage of system development. In this article, the author details the step-by-step process of software development that is recommended by the United States Food and Drug Administration (FDA) and utilized by the company in its development of a prevalidated sterilizer control system. By following FDA recommendations and using an external consultant to confirm validation, a prevalidated system can be supplied to the end-user. This provides the end-user with a number of significant benefits.
Computer-Aided Design↗
The Mosoriot medical record system: design and initial implementation of an outpatient electronic record system in rural Kenya.
Mosoriot Health Center is a rural primary care facility situated on the outskirts of Eldoret, Kenya in sub-Saharan Africa. The region is characterised by widespread poverty and a very poor technology infrastructure. Many houses do not have electricity, telephones or tap water. The health center does have electricity and tap water. In a collaborative project between Indiana University and the Moi University Faculty of Health Sciences (MUFHS), we designed a core electronic medical record system within the Mosoriot Health Center, with the intention of improving the quality of health data collection and, subsequently, patient care. The electronic medical record system will also be used to link clinical data from the health center to information collected from the public health surveys performed by medical students participating in the public health research programs of Moi University. This paper describes the processes involved in the development of the computer-based Mosoriot medical record system (MMRS) up to the point of implementation. It particularly focuses on the decisions and trade-offs that must be made when introducing this technology into an established health care system in a developing country.
Humans↗
[Emergency calls in the Samu system].
The French emergency medical system is public and medical. Named Samu, it is almost entirely managed by anesthesiologists specially trained for emergency medical assistance and advanced medical support. The system comprises a reception and dispatching center for emergency calls, directly connected to police and firemen, but assuring patient confidentiality. This fixed center is managing mobile units which are Medical Intensive Care Ambulances (MICA named Smur in France). The Samu's mission consists in performing urgent individual medical assistance and also medical services for treatment of mass casualties. It is also to find adequate hospital units for the patients, to perform medical transport and to be a consultant for general practitioners in emergency.
Accidents, Traffic↗
Comparison of topical medication delivery systems after sinus surgery.
OBJECTIVES: To compare the distribution patterns of topical medication delivery systems in the sinonasal region and upper respiratory tract after functional endoscopic sinus surgery. STUDY DESIGN: Prospective descriptive evaluation. METHODS: Four topical delivery systems (spray bottle, atomizer, nebulizer, and bulb syringe) were studied. Using a dye solution as a marker, we independently applied the four topical delivery systems to a population of patients with chronic rhinosinusitis who had undergone functional endoscopic sinus surgery. The anatomic distributions were videotaped using flexible fiberoptic endoscopy. Three blinded observers independently rated the anatomic distribution of dye using a 4 point scale. Statistical analysis was performed using analysis of variance (ANOVA) and Dunn posttesting. RESULTS: Seven participants completed the study. All participants had undergone bilateral maxillary antrostomies, bilateral total ethmoidectomies, and bilateral sphenoidotomies. Five sinonasal sites and the larynx were evaluated for dye deposition. Interobserver agreement reached 95.6%. There was no statistical difference between the atomizer and spray bottle. The bulb syringe was statistically superior to the nebulizer in all sinonasal sites and statistically superior to the atomizer and spray bottle in the ethmoidal region. Dye was rarely seen within the larynx. CONCLUSIONS: The delivery systems tested were shown to have significant differences in their capability to place dye in specific sinonasal areas. Because topical medications are commonly administered to postoperative patients, these differences may have important clinical implications.
Administration, Intranasal↗
[Does the present medical care system satisfy patients with home oxygen therapy (HOT) and home therapy with assisted ventilation (HTAV) in Japan?: an answer from a questionnaire analysis].
The aim of this study was to determine whether the present Japanese medical care system for home oxygen therapy (HOT) and home therapy with assisted ventilation (HTAV) satisfies patients (HOT & HTAV Pts) who receive these therapies. To clarify this issue, we sent questionnaires to 807 patients with HOT and HTAV, 816 practitioners (DRs), and 110 nursing stations (NSs) in metropolitan Tokyo. Responses were eventually received from 79.9% of HOT & HTAV Pts, 32.7% of Drs and 60.9% of NSs. As a result, going to hospitals on regular basis itself (1.3 times a month) forces HOT & HTAV Pts to spend a lot of money and time at present (22.4% spent more than 5,000 yen, and 15.5% more than 60 minutes for a consultation). Although a majority of HOT & HTAV Pts now see a respiratory specialist in larger hospitals, HOT & HTAV Pts wish to see DRs, if the DRs have sufficient ability in HOT and HTAV management. On the other hand, both DRs (86.9%) and NSs (90.6%) consider that case conferences and lectures regarding HOT and HTAV on a regular basis are essential. These meetings are attended by respiratory specialists, DRs, NSs, medical equipment dealers, HOT & HTAV Pts's family members and so forth, because both DRs and NSs feel a certain anxiety about seeing HOT & HTAV Pts (68.3% DRs and 7.5% NSs do not want to see HOT & HTAV Pts). In summary, 1) a majority of HOT & HTAV Pts remain unsatisfied with the present medical care system, 2) a vague anxiety about seeing HOT & HTAV Pts makes DRs tend to avoid HOT & HTAV Pts consultations, 3) NSs frequently feel unsure how to recognize and respond properly to problems concerning HOT & HTAV Pts (62.3%). We therefore conclude that if we could succeed in organizing a better medical care system for HOT & HTAV Pts than the present one, we could turn substantially improve the quality of life of HOT & HTAV Pts in Japan.
Home Care Services, Hospital-Based↗
[Computer databases and scientific and research information systems].
Medical informatics, especially computer data bases for collecting, processing and searching of scientific and research informations and publications is important for medical science and for the medical practice. Medical scientific informatics has developed as a special part of medical informatics. It is very important for medical education, medical research and publishing in biomedical disciplines. This paper presents the main characteristics of scientific and research information, their resources, searching of medical literature from biomedical journals. A historical survey of the foundation of the System for Biomedical Scientific Information in ex Yugoslavia (SBMNI) has been presented, with its conceptual basis, the current organization, the achieved results and experiences obtained.
Information Systems↗
Medical diagnostic system using Fuzzy Coloured Petri Nets under uncertainty.
We propose a medical diagnostic system using Fuzzy Coloured Petri Nets (FCPN) in this paper. For complex real-world knowledge Fuzzy Petri Net (FPN) models have been proposed to perform fuzzy reasoning automatically. However, in the Petri Net we have to represent all kinds of processes by separate subnets even though the process has the same behavior of other one. Real-world knowledge often contains many parts which are similar, but not identical. This means that the total PTN becomes very large. The kind of problems may be annoying for a small system, and it may be catastrophic for the description of large-scale system. To avoid this kind of problems we propose a learning and reasoning method using FCPNs under uncertainty. On the other hand to correct the rules of knowledge-based system hand-built classifier and empirical learning method both based on domain theory have been proposed as machine learning methods, where there is a significant gap between the knowledge-intensive approach in the former and the virtually knowledge-free approach in the later. To resolve such problems simultaneously we propose a hybrid learning method which is built on the top of knowledge-based FCPN and Genetic Algorithms (GA). To verify the validity and the effectiveness of the proposed system, we have successfully applied it to the diagnosis of intervertebral diseases.
Algorithms↗
A result-oriented medical information system. An alternative to the conventional approach.
A result-oriented medical information system at the Gulf Oil Corporation is described. Mortality data acquired mostly from routine company operations have been used to calculate standardized mortality ratios (SMRs) and life expectancy. Results show that male employees at the age of 20 have a life expectancy of 74.8 years. Compared with the U.S. general population at age 20 with a life expectancy of 71.8 years, Gulf employees have an advantage of exactly three years. Such an advantage may seem small, but it is equivalent to the gain that could be achieved if all deaths from cancer were eliminated in the United States, a hypothetical and impossible situation. These life expectancy data have the potential for use by the company to influence insurance premiums traditionally set by life insurance companies as well as to aid in the management of the company's pension fund. The SMR for all causes for the male employees is 0.82, significantly decreased in comparison with that of the U.S. general population. This favorable experience has been referred to as "the healthy worker effect." Cause-specific SMRs show a generalized pattern of deficits, some of which are statistically significant. None showed a significant increase. Seventy-six percent of the male deaths occurred among employees aged 65 years or older. If these annuitants (those alive at the beginning of the study) were not included and only the active workers were studied, an SMR of only 0.54 would be obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
Absenteeism↗
The development of a data security model for the Collaborative Social and Medical Services System.
This paper presents the development of the Collaborative Social and Medical Services System's (CSMSS) data security mechanism. This mechanism was synthesized from an analysis of the CSMSS problem domain, and from a study of the methods used by modern operating systems and database management systems. The resulting mechanism is more flexible and expressive than traditional access control methods and is generally applicable to the management of privacy and multi-provider access.
Ambulatory Care Information Systems↗
Liability immunity as a legal defense for recent emergency medical services system litigation.
BACKGROUND: Although many emergency medical services (EMS) providers are concerned about liability litigation, no comprehensive, national studies of EMS appelate cases have been published. Information about these cases and the use of liability immunity (sovereign immunity, emergency medical care immunity, or Good Samaritan immunity) as a defense could be used for EMS risk management and better patient care. OBJECTIVE: To review recent EMS system civil litigation cases to determine their common characteristics and the number that used liability immunity as a legal defense. METHODS: An observational study of the WESTLAW computerized database of legal cases from all state and federal appellate courts. All legal cases that named a member of the EMS system as a defendant, involved either a patient-care incident or ambulance collision, and received an appellate court opinion from 1987 through 1992, were studied. RESULTS: Eighty-six cases were identified and analyzed. Most cases (85%) were related to a patient-care incident, and 71% of the cases involved a death or significant physical injury. More than 49% of the patient cases alleged inadequate assessment or treatment, and 27% alleged delay in ambulance arrival or no ambulance arrival. There were 11 cases (15%) that alleged no transport of the patient to the hospital. Liability immunity was used as a defense in 53% of the cases. The appellate courts ruled in favor of 68% of the defendants that did not use an immunity defense and in favor of 72% of those that did use liability immunity. CONCLUSION: There have been a large number of recent appellate cases involving EMS systems. The common characteristics of many of these cases demonstrate the need for providing rapid ambulance arrival, proper assessment and treatment, and rapid patient transportation to a hospital. Although liability immunity was used as a legal defense by most EMS system defendants, the appellate court outcome was similar regardless of its use.
Defensive Medicine↗
Drug-induced corneal complications.
PURPOSE OF REVIEW: To review the common corneal manifestations of systemic medications in order to describe the characteristic clinical features associated with particular systemic drugs, the indications for drug cessation, and the risks for irreversible ocular toxicity. RECENT FINDINGS: Systemic medications may reach the cornea via the tear film, aqueous humor, and limbal vasculature. The corneal changes are often the result of the underlying chemical properties of medications. Amphiphilic medications (amiodarone, chloroquine, suramin, clofazimine, etc.) may produce a drug-induced lipidosis and development of a vortex keratopathy. Antimetabolites (cytarabine) may lead to a degeneration of basal epithelial cells with formation of epithelial microcysts. Additionally, systemically administered medications and drug metabolites may lead to a stromal or endothelial deposition. Corneal changes may result in reduced visual acuity, photophobia, and ocular irritation, though these symptoms typically resolve following drug cessation. Corneal manifestations of systemic medications are often dose related, and may reflect the potential risk for lenticular or retinal changes. SUMMARY: Corneal changes secondary to systemic medications may affect all layers of the cornea. While corneal deposition is typically not an indication for drug cessation, patients receiving particular medications should be monitored for symptoms related to corneal deposition as well as for signs of irreversible ocular toxicity.
Corneal Diseases↗